Registration

Please note that:
1. Payment is only possible via iDEAL or by Creditcard (via PayPal) and
2. This form must be completed at once, so please keep your card and personal data at hand!

Fields marked with * are obligatory to process your registration.

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PERSONAL DETAILS

Salutation *

First name *

Prefix

Family name *

Email address *

Please repeat your Email address *

Phone number *

Company/Institute *

Please specify your company/institute *

Position *

Please specify your position *

In what subject are you most interested? *

Please specify the subject *

Are you a member of the Royal Netherlands Chemical Society (KNCV)? *

Yes, I am a member of the KNCV.

No, I am not a member of the KNCV, but I would like to receive more information about the society and member benefits.

No, I am not a member of the KNCV

PACKAGE SELECTION

I am joining the following day(s) of CHAINS *

Package 1A (single day - Tuesday 05-12) - € 75,00

Package 1B (single day - Wednesday 06-12) - € 75,00

Package 1C (single day - Thursday 07-12) - € 75,00

Package 2A (Tuesday 05-12 & Wednesday 06-12) - € 150,00

Package 2B (Wednesday 06-12 & Thursday 07-12) - € 150,00

Package 3 (All three days 05-12/06-12/07-12) - € 250,00

The early bird deadline expires 2 October 2017 at 13:00 hrs. After this date the full rate will apply, i.e. package 1: € 75,-, package 2A/2B: € 150,- and package 3: € 250,-.

Do want to attend the dinner on Wednesday, the plenary day? We will charge you additionally € 25,00 *

Yes

No

Do you want to make use of a hotel room? *

Yes, single room

Yes, double room

No

Ph.D. students, Postdocs, B.Sc and M.Sc. students and technicians are automatically assigned a double room which they have to share (this may be someone you don’t know, however from the same gender). We will try to take your wishes into account.
Please note that sharing a room with a preferred roommate is only possible, when:
1) the roommate him/herself attends CHAINS for the same days as you do,
2) the roommate indicates in his/her registration form your name and matching email address.

Do you have a prefered roommate? *

Yes

No

Who would you like to share a room with?
Please fill out the email address this person is registering with for CHAINS 2017. *

Do you want to book an additional night? *

Yes

No

It is possible to book additional overnight stays at the NH Koningshof, but those nights will be at your own expense. These costs need to be paid at check-in at the hotel

What is the date of the extra night? *

December 4th 2017

December 5th 2017

December 6th 2017

December 7th 2017

Would you be interested in child care facilities on site? *

Yes

No

On which days of the conference would you like to make use of child care facilities? *

Tuesday 5 December

Wednesday 6 December

Thursday 7 December

Would you be interested in free bus service from Eindhoven station to NH De Koningshof (vice versa)? *

Yes

No

On which days of the conference would you like to make use of free bus service from Eindhoven station to NH De Koningshof (vice versa)? *

Tuesday 5 December

Wednesday 6 December

Thursday 7 December

INVOICE DETAILS

Please fill in the below details, which will be used for generating your personalized invoice. Include the required reference code(s) and postal address of your organization. If you don’t know these, contact your own financial department for more information. Modifications in this section of the registration form can however also be made afterwards, when you receive your login details.

Organisation/in the name of (specific for invoice)

Postal Address *

Postal Code *

City *

Country *

Any specific references for your invoice (if applicable)

SUMMARY REGISTRATION

Terms and conditions *
You can cancel your registration free of charge by 10 November 2017. If you cancel your registration between 11 and 24 November, a € 50,- fee will be charged (from your refunded registration fee). In case you do not cancel your registration by 24 November at the latest or in case you do not use your pre-booked hotel room or in case you do not show up at CHAINS, NWO will charge you a € 80,- handling fee. Your registration fee will not be refunded.
You can cancel your registration by sending an email to Yvonne Kuitenbrouwer: chains2017@db-eventmarketing.nl with reference to "cancellation chains".

Yes, I agree with the terms and conditions

Sign up for newsletter

Yes, I would like to subscribe for the NWO newsletter Dutch Chemistry News and receive the latest information on CHAINS 2017.

Special wishes (e.g. dietary requirements)

Discount code

Order overview

Product

Quantity

Price

Total

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